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Lopinavir/ritonavir for treatment of non-hospitalized patients with COVID-19: a randomized clinical trial

Kaizer et al., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2022.12.028, TREATNOW, NCT04372628, Mar 2023
https://c19early.org/kaizer.html
Mortality -203% Improvement Relative Risk Hospitalization -20% Recovery -3% Lopinavir/r..  TREATNOW  LATE TREATMENT  DB RCT Is late treatment with lopinavir/ritonavir beneficial for COVID-19? Double-blind RCT 446 patients in the USA (June 2020 - December 2021) Higher mortality with lopinavir/ritonavir (not stat. sig., p=0.49) c19early.org Kaizer et al., Int. J. Infectious Dise.., Mar 2023 Favorslopinavir/ritonavir Favorscontrol 0 0.5 1 1.5 2+
RCT 437 non-hospitalized COVID-19 patients showing no significant differences with lopinavir/ritonavir (LPV/r) treatment.
Standard of Care (SOC) for COVID-19 in the study country, the USA, is very poor with very low average efficacy for approved treatments1. Only expensive, high-profit treatments were approved for early treatment. Low-cost treatments were excluded, reducing the probability of early treatment due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments.
risk of death, 202.7% higher, RR 3.03, p = 0.49, treatment 1 of 220 (0.5%), control 0 of 226 (0.0%), continuity correction due to zero event (with reciprocal of the contrasting arm).
risk of hospitalization, 19.8% higher, RR 1.20, p = 0.78, treatment 7 of 220 (3.2%), control 6 of 226 (2.7%).
risk of no recovery, 3.1% higher, HR 1.03, p = 0.88, treatment 220, control 226, inverted to make HR<1 favor treatment, ordinal category, day 15.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Kaizer et al., 31 Mar 2023, Double Blind Randomized Controlled Trial, placebo-controlled, USA, peer-reviewed, mean age 41.0, 16 authors, study period June 2020 - December 2021, trial NCT04372628 (history) (TREATNOW). Contact: adit.ginde@cuanschutz.edu.
Lopinavir/ritonavir for treatment of non-hospitalized patients with COVID-19: a randomized clinical trial
Alexander M Kaizer, Nathan I Shapiro, Jessica Wild, Samuel M Brown, B Jessica Cwik, Kimberly W Hart, Alan E Jones, Michael S Pulia, Wesley H Self, Clay Smith, Stephanie A Smith, Patrick C Ng, B Taylor Thompson, Todd W Rice, Christopher J Lindsell, Adit A Ginde
International Journal of Infectious Diseases, doi:10.1016/j.ijid.2022.12.028
Objectives: Effective and widely available therapies are still needed for outpatients with COVID-19. We aimed to evaluate the efficacy and safety of lopinavir/ritonavir (LPV/r) for early treatment of nonhospitalized individuals diagnosed with COVID-19. Methods: This randomized, placebo (Plb)-controlled, double-blind, multi-site decentralized clinical trial enrolled non-hospitalized adults with confirmed SARS-CoV-2 infection and six or fewer days of acute respiratory infection symptoms who were randomized to either twice-daily oral LPV/r (400 mg/100 mg) or Plb for 14 days. Daily surveys on study days 1 through 16 and again on study day 28 evaluated symptoms, daily activities, and hospitalization status. The primary outcome was longitudinal change in an ordinal scale based on a combination of symptoms, activity, and hospitalization status through day 15 and was analyzed by use of a Bayesian longitudinal proportional odds logistic regression model for estimating the probability of a superior recovery for LPV/r over Plb (odds ratio > 1). Results: Between June 2020 and December 2021, 448 participants were randomized to receive either LPV/r (n = 216) or Plb (n = 221). The mean symptom duration before randomization was 4.3 days (SD 1.3). There were no differences between treatment groups through the first 15 days for the ordinal primary outcome (odds ratio 0.96; 95% credible interval: 0.66 to 1.41). There were 3.2% (n = 7) of LPV/r and 2.7% (n = 6) of Plb participants hospitalized by day 28. Serious adverse events did not differ between groups. Conclusion: LPV/r did not significantly improve symptom resolution or reduce hospitalization in nonhospitalized participants with COVID-19.
Author contributions Funding was obtained by NIS, TWR, and AAG. The study was designed by AMK, NIS, TWR, CJL, and AAG. The underlying data were verified by AMK, JW, and KWH, and data analyses were done by AMK. AMK wrote the first draft of the manuscript. All authors interpreted data, provided critical review and revision of the text, and approved the final version of the manuscript. AAG takes responsibility for the manuscript as a whole. Disclaimer The views expressed are those of the author(s) and do not reflect the official views or policy of the Department of Defense or its Components. The voluntary, fully informed consent of the subjects used in this research was obtained as required by 32 CFR 219 and DODI 3216.02_AFI 40-402. Data sharing statement Deidentified data from the Trial of Early Antiviral Therapies during Non-hospitalized Outpatient Window (TREAT NOW) trial will be made available 1 year after publication of final results from the platform by written request, contingent on approval from the trial steering committee. Supporting documents will be made available, including the protocol, statistical analysis plan, informed consent document, and data dictionary. Data will be made available to researchers after approval of a proposal for use of the data. Supplementary materials Supplementary material associated with this article can be found, in the online version, at doi: 10.1016/j.ijid.2022.12.028 .
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Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 200,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. IMA and WCH provide treatment protocols.
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